Health Services for Refugees in the United States: Policies and Recommendations

Some of refugees, who were forced to move out from a home country due to political or religious conflicts, war or natural or manmade disasters, resettle in another country. Resettlement in another country is challenging as refugees suffer from a number of mental and physical health problems. Under the Refugee Act of 1980, the United State (US) governments provide medical assistance as well as financial and immigration legal assistance. Yet, it is still challenging to ensure health and well-being of refugees who have diverse social and health conditions and needs. This study reviewed federal policies and limitations on refugee health in the US, which accepts the largest number of refugee resettlements in the world. The reviewed policies include health insurance policies, health promotion policies, the Survivors of Torture Program, and medical screening. Some refugees still have limited accessibility to services due to difficulties in understanding the healthcare system even when they are eligible for many of the services. While most policies on refugee health mainly focus on the early stage of resettlement and infectious disease screening, follow-up services for chronic conditions are essential to ensure health and well-being of refugees. Because social factors affect health of refugees, it is necessary to provide services that address social and health issues. There are several recommendations to improve policies and services to better serve refugee populations who resettled in the US. First, more comprehensive health promotion and education programs are necessary for refugees to better understand the US healthcare system and healthcare. Second, long-term follow-ups which include chronic health conditions are important to improve health of refugees. Lastly, social and health issues should be integrated with a bidirectional approach which supports both refugees and existing communities. Keywords: refugees, physical and mental health, resettlement, federal policies, United States

Policy and Social Factors Influencing Diabetes among Pima Indians in Arizona, USA

The Pima Indians have the highest rate of type 2 diabetes in the world. While biomedical studies have identified a genetic variable associated with the high prevalence of diabetes among Pima Indians, genetics is only one factor that encompasses an individual’s risk for developing a disease. Information on the social factors relating to the development of type 2 diabetes amongst this population is necessary. The purpose of this analysis is to review policy, social and historical factors associated with diabetes among Pima Indians. Governmental policies have affected this population’s ability to eat a diet native to their culture. For example, the damming of the Gila River in the early 1920s resulted in diet and lifestyle changes, reducing traditional low fat, high fiber intake and physical activity, among the Pima population. U.S. Department of Agriculture (USDA) policies in place in the 1970s and 1980s did not allow Native Americans, the Pima included, to get farm help such as agricultural loans in times of need. These policies led to many Pima finding sedentary jobs, if they could find work at all, and adopting unhealthy lifestyles. While genetic factors have shown to be important predictors of diabetes incidence, the historical and social factors that changed US Pima Indians’ lifestyles are significant factors which have contributed to the high prevalence of diabetes among this group. In order to address the high rates of diabetes among the Pima Indians, it is vital that emphasis be placed upon culturally appropriate interventions. U.S. government agencies, tribal leaders, and community elders would benefit from working together to establish healthier food sources, encourage physical activity, and utilize existing community networks to spread information on diabetes prevention and management practices. Future studies on diabetes among Pima Indians would include more policy, social and historical factors, develop programs with reflection of these factors, and evaluate the programs. Keywords: Pima Indians, type 2 diabetes, Native American policies, social factors, US

Gender Roles and Women’s Health in India

One of the main determinants of the poor health status among women in India is a women’s disadvantaged gender role. This study aims to identify the factors that affect women’s health, and particularly focuses on women’s ability to make decisions in a family concerning health-related issues and education. The data are from the India Human Development Survey-II (IHDS-II), 2011-12 (ICPSR 36151), which includes nationally representative samples across India. Women who have more decision making power within a family had better self-reported health. Women who are more educated have better self-reported health. Self-reported women's health status was dependent on the rank of castes to which the women belonged. Our results suggest that decision-making power and education play a key role in improving the health outcomes for women in India. Health promotion programs for women in India should include a platform for gender roles and decision-making capacity. Keywords: women’s health; gender roles; decision-making power; Indi

Sun Protection Behaviors Associated with Self-Efficacy, Susceptibility, and Awareness among Uninsured Primary Care Patients Utilizing a Free Clinic

Background. Skin cancer is the most commonly diagnosed form of cancer in the United States (US). However, knowledge, behaviors, and attitudes regarding sun protection vary among the general population. The purpose of this study is to examine sun protection behaviors of low-income primary care patients and assess the association between these health behaviors and the self-efficacy, susceptibility, and skin cancer awareness. Methods. Uninsured primary care patients utilizing a free clinic (N=551) completed a self-administered survey in May and June 2015. Results. Using sunscreen was the least common tactic among the participants of this study. Skin cancer awareness and self-efficacy are important to improve sun protection behaviors. Spanish speakers may have lower levels of skin care awareness compared to US born and non-US born English speakers. Male and female participants use different sun protection methods. Conclusion. It is important to increase skin cancer awareness with self-efficacy interventions as well as education on low-cost sun protection methods. Spanish speaking patients would be a target population for promoting awareness. Male and female patients would need separate gender-specific sun protection education. Future studies should implement educational programs and assess the effectiveness of the programs to further promote skin cancer prevention among underserved populations

Perceived concern about the new strain of the influenza and obtaining the vaccine in China, Japan and South Korea

This study compares the factors, which influence individuals from the countries of China, Japan and South Korea to obtain any type of influenza vaccines and their perceived concerns about the new strain of the influenza - pandemic (H1N1) 2009. The data analyzed was from the East Asian Social Survey (EASS), Cross-National Survey Data Sets: Health and Society in East Asia, 2010 (ICPSR 34608) (N = 7938). The results of this study suggest that individuals who are concerned about the new strain of influenza are more likely to have obtained influenza vaccine. In these countries, perceived concerns may be directly related to vaccine-related behaviors. The results of this study also indicate that there are variations within each country regarding as to why individuals do or do not obtain the influenza vaccine. Over all, this project provides new insights about the acquisition of the influenza vaccine within China, Japan and South Korea, which will be useful for medical practice within these countries and future research. Keywords: influenza vaccine, perceptions, social factors, China, Japan, South Kore

Knowledge and Perceptions of Influenza Vaccinations Among College Students in Vietnam and the United States

Objectives Influenza is a significant worldwide public health issue. Knowledge and perceptions regarding the flu vaccination are associated with whether individuals obtain the vaccination. The purpose of this study was to examine how such perceptions were related to knowledge and self-efficacy regarding influenza and the flu vaccination in Vietnam and the US. Methods College students (n=932) in Vietnam (n=495) and the US (n=437) completed a self-administered survey regarding knowledge and perceptions of influenza vaccinations in September and October 2016. Results Vietnamese participants reported significantly lower levels of awareness about flu risk, higher levels of negative attitudes toward flu vaccination, lower levels of knowledge about the flu and vaccination, and lower levels of self-efficacy than US participants. Higher levels of flu and flu vaccination knowledge and self-efficacy regarding general responsible health practices were associated with lower levels of negative perceptions of flu risk and attitudes toward vaccination. At the same time, self-efficacy regarding responsible health practices was associated with higher levels of awareness of flu risk and lower levels of negative attitudes toward vaccination. Self-efficacy regarding exercise was associated with lower levels of perceptions of flu risk and higher levels of negative attitudes toward vaccination. Conclusions Vietnam could benefit from influenza education based on this comparison with the US. In both countries, knowledge and self-efficacy were found to be important factors influencing perceptions of influenza risk and vaccination

Knowledge and beliefs about HPV among college students in Vietnam and the United States

Any sexually active person has the possibility of contracting the human papillomavirus (HPV) sometime in their lifetime. HPV vaccines are effective in preventing HPV if obtained prior to viral exposure. Research on knowledge and beliefs of HPV and HPV vaccination among college students in Vietnam is significantly scarce. The purpose of this study is to examine the knowledge and beliefs about HPV among college students in Vietnam compared to college students in the US. This cross-cultural comparison will fill a void in current research on this subject. Over 900 college students (N = 932: n = 495 in Vietnam and n = 437 in the US) participated in a self-administered survey on the knowledge and beliefs about HPV in September and October 2016. Vietnamese participants reported lower levels of knowledge and experiences with the HPV virus and vaccines (p < 0.01). Additionally, Vietnamese participants also exhibited more barriers in obtaining the vaccination, as well as, HPV risk denial (p < 0.01). The level of knowledge is an important predictor of barriers (p < 0.01; ηp2=0.022) and risk denial (p < 0.01; ηp2=0.116). On average, both Vietnamese and US participants could correctly answer less than half of the survey questions regarding HPV knowledge. Additionally, provider recommendations are potentially more important than informal connections (e.g. friends, family) to reduce barriers to HPV vaccination (p < 0.01; ηp2=0.035) and denial of HPV risks (p < 0.05; ηp2=0.008). The increase of knowledge about HPV prevention, including and vaccination, has the potential to be improved through provider interventions. Vietnam could take action toward promoting HPV vaccinations not only at an individual level but also at a national or local level. Further research may examine the effects of a lack of knowledge on HPV-related health outcomes. Keywords: Human papillomavirus, HPV vaccination, Knowledge, Beliefs, College students, Vietnam, US

Impact of capnography on patient safety in high- and low-income settings: a scoping review.

BACKGROUND:Capnography is universally accepted as an essential patient safety monitor in high-income countries (HICs) yet is often unavailable in low and middle-income countries (LMICs). Increasing capnography availability has been proposed as one of many potential approaches to improving perioperative outcomes in LMICs. This scoping review summarises the existing literature on the effect of capnography on patient outcomes to help prioritise interventions and guide expansion of capnography in LMICs. METHODS:We searched MEDLINE and EMBASE databases for articles published between 1980 and March 2019. Studies that assessed the impact of capnography on morbidity, mortality, or the use of airway interventions both inside and outside the operating room were included. RESULTS:The search resulted in 7445 unique papers, and 31 were included for analysis. Retrospective and non-randomised data suggest capnography use may improve outcomes in the operating room, ICU, and emergency department, and during resuscitation. Prospective data on capnography use for procedural sedation suggest earlier detection of hypoventilation and a reduction in haemoglobin desaturation events. No randomised studies exist that assess the impact of capnography on patient outcomes. CONCLUSION:Despite widespread endorsement of capnography as a mandatory perioperative monitor, rigorous data demonstrating its impact on patient outcomes are limited, especially in LMICs. The association between capnography use and a reduction in serious airway complications suggests that closing the capnography gap in LMICs may represent a significant opportunity to improve patient safety. Additional data are needed to quantify the global capnography gap and better understand the barriers to capnography scale-up in LMICs